The goals of the pediatric HIV research effort are to conduct translational research aimed at developing improved therapies for children with HIV infection and HIV-associated malignancies, to understand the pathogenesis of pediatric HIV disease, and to study the impact of pediatric HIV disease on the patients and their families. Both antiretroviral and immunologic approaches for HIV therapy are currently being investigated. As a result of strategic changes in priority, this project has been substantially reduced in scope since FY2005. However, some meritorious work is continuing, being done largely by Dr. Rohan Hazra (a Staff Physician who also has an adjoint appointment in HAMB) and Julia Purdy (a member of the HAMB Office of the Chief). We have closed the protocols on the use of tenofovir, a nucleotide analog reverse transcriptase inhibitor, in HIV-infected children who have failed previous regimens and have multidrug resistant virus began to yield published results. We are now in the process of analyzing the results of this study and writing it up. Dr. Hazra has initiated a protocol to study CNS disease in HIV-infected children in the HAART era. This CNS study will take advantage of a collaboration with NINDS and the Clinical Center's Departments of Diagnostic Radiology and Laboratory Medicine and will include brain MRI and magnetic resonance spectroscopy and examination of virologic and neuroinflammatory factors in the CSF. It also expands upon a longstanding effort within the group to understand the neuropsychological dimensions of pediatric HIV disease. Other recently completed neuropsychologic studies include a published report on the coping styles of families of HIV-infected children and a recently completed protocol examining the relationship between psychological variables and adherence to HAART. We have also engaged in a longstanding effort to understand the psychosocial dimensions of pediatric HIV disease. Several clinical trials in this project were recently terminated, and the overall level of effort in this project was decreased substantially. The needs of patients with regard to this transition have been studied in an attempt to understand the ability of pediatric HIV patients and their families to adjust to such changes and to assist them in the transition. The work is 100% AIDS research.